Medical dressing comprising a flap

ABSTRACT

The disclosed medical dressing has a dressing body and a flap. The dressing body has a first major surface and opposite second major surface containing a skin-contact adhesive. The flap has a fixed end integrally connected to the dressing body and a movable free end. The second major surface of the flap has a securing adhesive for contact with the first major surface of the dressing body.

CROSS REFERENCE TO RELATED APPLICATIONS

This is continuation of U.S. application Ser. No. 14/652,152, filed Jun.15, 2015, which was a national stage filing under 35 U.S.C. § 371 ofPCT/US2013/075252, filed Dec. 16, 2013, which claims priority to U.S.Provisional Application Nos. 61/783,582, filed Mar. 14, 2013 and61/740,778, filed Dec. 21, 2012, the disclosures of which areincorporated herein by reference in their entirety.

FIELD

The present disclosure relates to a medical dressing comprising a flap.In particular, the present disclosure relates to a medical dressing forsafely and reliably securing a medical article, such as a cathetersystem, upon a desired location of a patient's body.

BACKGROUND

Medical adhesive dressings are used for a variety of medicalapplications, such as for securing medical devices to skin. Adhesivedressings can provide barrier protection from infectious species to awound or catheter insertion site. Transparent adhesive dressings arecommonly used at a catheter insertion site because visual monitoring ofthe site can be achieved without removing the dressing. Poor or weaksecurement of an inserted medical device can increase the risk forpotential infiltration of antagonistic microbes which can result in theneed for device reinsertion or can lead to complications such asphlebitis and catheter related bloodstream infections (CRBSIs). When apatient experiences a CRBSI, mortality and morbidity rates increasesignificantly. Because loss of a catheter line or other medical devicecan be so devastating for the patient, adhesives which have strongadhesion to the skin are often used to secure such devices; theseadhesives, however, can be very damaging to skin when removed. Use of amore gentle adhesive can significantly reduce skin damage such as edema,erythema, and skin stripping or tearing. Common gentle adhesives (e.g.,silicone-based adhesives), however, typically have poor adhesion to theinserted medical devices and/or tubing.

SUMMARY

The present disclosure generally relates to medical dressing comprisinga flap (e.g., a tape flap) for safely and reliably securing a medicalarticle, such as a catheter system, upon a desired location of apatient's body. In general, the medical dressing can include a dressingbody that adheres to the patient's skin, and a flap having a fixed endcoupled to the dressing body that secures at least a portion of themedical article, e.g., in some embodiments, with a more aggressiveadhesive than what is used to secure the dressing body to the skin.

Some aspects of the present disclosure provide a medical dressing, e.g.,for securing a medical article to a skin surface. The medical dressingcan include a dressing body comprising a first major surface, and asecond major surface, opposite the first major surface, comprising askin-contact adhesive. The medical dressing can further include a flapcomprising a first major surface; a second major surface, opposite thefirst major surface; a fixed end coupled to the dressing body; and afree end movable with respect to the dressing body between a firstposition in which the free end is not positioned in an overlappingrelationship with the dressing body and a second position in which thefree end is positioned in overlapping relationship with the dressingbody. The second major surface of at least the free end of the flap canbe configured to be secured to the dressing body, and the flap can belocated toward a proximal end of the dressing body, such that a distalportion of the dressing body is free of the flap.

Some aspects of the present disclosure provide a medical dressing. Themedical dressing can include a dressing body comprising a first majorsurface, and a second major surface, opposite the first major surface.At least a portion of the second major surface can include a siliconeadhesive. The medical dressing can further include a flap comprising afirst major surface; a second major surface, opposite the first majorsurface; a fixed end coupled to the dressing body; and a free endmovable with respect to the dressing body between an open position inwhich the free end is not positioned in an overlapping relationship withthe dressing body and a second position in which the free end ispositioned in overlapping relationship with the dressing body. At leastthe free end of the flap can be configured to be secured to the dressingbody by an acrylate adhesive when the free end of the flap is in thesecond position.

Other features and aspects of the present disclosure will becomeapparent by consideration of the detailed description and accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a medical dressing according to oneembodiment of the present disclosure, showing the medical dressing beingused to couple a medical article to a patient.

FIG. 2 is a perspective view of the medical dressing of FIG. 1, withrelease liners and a frame.

FIGS. 3-5 illustrate a method for coupling a medical article to apatient with the medical dressing of FIGS. 1-2.

FIG. 6 is a cross-sectional view of the medical dressing of FIGS. 1-5,taken along line 6-6 of FIG. 5.

FIG. 7 is a top plan view of a medical dressing according to anotherembodiment of the present disclosure, shown prior to use.

FIG. 8 is an end view of the medical dressing of FIG. 7, shown in usewith a medical article.

FIG. 9 is a top plan view of a medical dressing according to anotherembodiment of the present disclosure.

FIG. 10 is a side view of the medical dressing of FIG. 9.

FIG. 11 is a top plan view of a medical dressing according to anotherembodiment of the present disclosure.

FIG. 12 is a top plan view of a medical dressing according to anotherembodiment of the present disclosure.

FIG. 13 is a top plan view of a medical dressing according to anotherembodiment of the present disclosure.

FIG. 14 is a top plan view of a medical dressing according to anotherembodiment of the present disclosure.

DETAILED DESCRIPTION

Before any embodiments of the present disclosure are explained indetail, it is to be understood that the invention is not limited in itsapplication to the details of construction and the arrangement ofcomponents set forth in the following description or illustrated in thefollowing drawings. The invention is capable of other embodiments and ofbeing practiced or of being carried out in various ways. Also, it is tobe understood that the phraseology and terminology used herein is forthe purpose of description and should not be regarded as limiting. Theuse of “including,” “comprising,” or “having” and variations thereofherein is meant to encompass the items listed thereafter and equivalentsthereof as well as additional items. Unless specified or limitedotherwise, the term “coupled” and variations thereof are used broadlyand encompass both direct and indirect couplings. It is to be understoodthat other embodiments may be utilized and structural or logical changesmay be made without departing from the scope of the present disclosure.Furthermore, terms such as “top,” “bottom,” and the like are only usedto describe elements as they relate to one another, but are in no waymeant to recite specific orientations of the apparatus, to indicate orimply necessary or required orientations of the apparatus, or to specifyhow the invention described herein will be used, mounted, displayed, orpositioned in use.

The present disclosure generally relates to medical dressing comprisinga flap for safely and reliably securing a medical article, such as acatheter system, upon a desired location of a patient's body. Themedical dressing can include a dressing body that includes a lessaggressive adhesive for adhering to skin and a flap that has a fixed endcoupled to the dressing body and that includes a more aggressiveadhesive for reliably securing at least a portion of the medicalarticle, for example, by adhering to a top surface of the dressing bodyrather than the skin.

The medical dressings of the present disclosure can be universal toaccommodate and reliably secure a large variety of medical articles orclass of medical articles (e.g., PICCs, CVCs, Inserted Ports, PIVs,etc.), and can be particularly useful for securing medical articles thatneed to be secured to a patient over a prolonged period of time, such asweeks or months.

Examples of medical articles that can be employed with the medicaldressings of the present disclosure include, but are not limited to,connector fittings, catheter systems (e.g., including catheters,catheter hubs, catheter adaptors, etc.), fluid supply lines, insertedports, other similar articles, or combinations thereof. Examples ofcatheter systems can include, but are not limited to, intravenous (IV)catheters (e.g., peripheral intravenous catheters PIVs), central venouscatheters (CVCs), peripherally inserted central catheters (PICCs),arterial catheters, urinary catheters, and dialysis catheters.

The terms “longitudinal” and “axial” are used to refer to a direction oraxis that is generally parallel to the direction in which the medicalarticle extends and generally parallel to the overall direction of fluidflow, e.g., along a catheter line.

The term “lateral” or “transverse” is used to refer to a direction oraxis that is perpendicular to the longitudinal axis or direction and isused to represent side-to-side motion of a medical article.

The terms “vertical” and “normal” are used to refer to a direction oraxis that is normal to both the longitudinal and lateral directions oraxes, as well as to the surface of a patient's skin when the medicaldressing is coupled to the patient's skin, and is used to represent thedirection of motion toward and away from the skin surface.

The term “proximal” and “distal” are used to represent axial directions,relative to a medical practitioner operating or holding the medicalarticle. That is, the term “distal” is used to refer to the directionaway from the medical practitioner (and toward an insertion site on thepatient and inside the patient's body), and the term “proximal” is usedto refer to the direction toward the medical practitioner (and towardthe outside of the patient's body, away from the insertion site). Forexample, the distal end of a catheter is inserted into the patient,while the proximal end extends exterior of the patient toward themedical practitioner. The distal end of the medical dressing refers tothe end of the medical dressing that is configured to be oriented towardthe distal end of the medical article to which it will be coupled, andthe proximal end of the medical dressing refers to the end of themedical dressing that is configured to be oriented toward the proximalend of the medical article. As a result, in the case of cathetersystems, the distal end of the medical dressing will be oriented towardthe insertion site on the patient's body, and the proximal end of the ofthe medical dressing will be oriented away from the insertion site onthe patient's body.

FIGS. 1-6 illustrate a medical dressing 100 according to one embodimentof the present disclosure. FIG. 1 illustrates a medical dressing 100coupled to the skin 50 of a patient, and particularly, to an arm of thepatient. FIG. 1 also illustrates an exemplary medical article 60 coupledto the medical dressing 100. By way of example only, the medical article60 is illustrated as being a catheter system which can include one ormore input catheters (or tubes or lines) 62, a catheter hub 64, and oneor more output catheters (or tubes or lines) 66. FIG. 2 shows themedical dressing 100 prior to coupling the medical dressing 100 to thepatient.

As shown, the medical article 60 can have a longitudinal axis A thatextends along and defines a longitudinal direction. The medical articlecan extend distally to include a first longitudinal, distal end orportion 68 (which may extend beyond what is shown in FIG. 1, e.g., intoan interior of the patient's body), and can extend proximally to includea second longitudinal, proximal end or portion 70 (which may extendfurther proximally and include additional elements than what is shown inFIG. 1).

By way of example only, the distal portion 68 of the medical article 60is shown as entering a peripheral vein in a patient's arm at aninsertion site 65, and the proximal portion 70 is shown to include oneinput catheter 62, which can terminate at a connector (not shown). Sucha connector can be connected to a fluid supply line, or the like, fordelivery of a variety of nutrients or medicaments to the patient.

As shown, the medical dressing 100 can include a dressing body 102 and aflap 104. The dressing body 102 can include a first major surface (e.g.,a top major surface) 110 configured to face away from the patient's skin50, and a second major surface (e.g., a bottom major surface) 112opposite the first major surface 110 that comprises a skin-contactadhesive 115 (see FIGS. 2 and 6) for adhering to the skin 50. Thedressing body 102 can include a distal end 105 and a proximal end 107,and accordingly, a distal portion 106 located toward the distal end 105,and a proximal portion 108 located toward the proximal end 107. Asshown, in some embodiments, the distal portion 106 of the dressing body102 can include a transparent window 109 that can be located over aportion (e.g., the distal portion 68) of the medical article 60 and/orthe patient's skin 50 that is desired to be monitored while the medicaldressing 100 is coupled to the patient without having to remove themedical dressing 100.

The flap 104 can include a first major surface (e.g., a top majorsurface) 114 and a second major surface (e.g., a bottom major surface)116, opposite the first major surface 114. The second major surface 116can include a securing adhesive 117 for securing at least a portion ofthe medical article 60, for example, to the first major surface 110 ofthe dressing body 102. The flap 104 can further include a fixed end 120coupled to the dressing body 102 and a free end 122 movable with respectto the dressing body 102 between a first (i.e., open) position P₁ (seeFIGS. 2-4) in which the free end 122 is not positioned in an overlappingrelationship with the dressing body 102 and a second (i.e., closed)position P₂ (see FIGS. 1, 5 and 6) in which the free end 122 ispositioned in overlapping relationship with the dressing body 102.

The securing adhesive 117 is shown and described by way of example only,but it should be understood that in any of the embodiments described andillustrated herein, the flap 104 can instead be secured to the dressingbody 102 using another type of fastener or fastener system, such as amechanical fastener. A mechanical fastener can include, but is notlimited to, a hook-and-loop fastener, a hook-and-stem fastener, ahook-and-hook fastener, a stem-and-stem fastener, or the like, orcombinations thereof. Still, other types of fasteners can be employed inmedical dressings of the present disclosure. In some embodiments, asecuring adhesive can be a preferred means for fastening at least thefree end 122 of the flap 104 to the dressing body 102, e.g., for hygieneand sanitation purposes.

As shown, at least a portion of the second major surface 116 of at leastthe free end 122 of the flap 104 can be configured to be secured to thedressing body 102 (i.e., to the first major surface 110 of the dressingbody 102) by the securing adhesive 117, i.e., when the free end 122 ofthe flap 104 is in the second position P₂. As shown, the flap 104 can belocated toward or adjacent the proximal end 107 of the dressing body 102and can be configured to overlap the proximal portion 108 of thedressing body 102, such that the distal portion 106 of the dressing body102 is free of the flap 104. Such a configuration can be importantparticularly in embodiments of the medical dressing 100 employing thetransparent window 109, for example, so that the flap 104 is locatedproximally with respect to the transparent window 109 and does notinterfere with visually monitoring at least a portion of the medicalarticle 60 and/or the patient, such as the insertion site 65 if acatheter system is employed.

As shown in FIG. 1, the flap 104 can be particularly suitable forsecuring the medical article 60 adjacent the first major surface 110 ofthe dressing body 102, for example, from undesired longitudinal, lateraland/or vertical movement while the medical article 60 is coupled to thepatient. As such, the dressing body 102 can secure the distal portion 68of the medical article 60, and the flap 104 can function with thedressing body 102 to further secure the proximal portion 70 of themedical article 60.

Although only a single shape of the dressing body 102 is illustrated, itshould be understood that the dressing body 102 can take on a variety ofshapes and sizes, depending on the shape and configuration of themedical article 60 to be employed. In some embodiments, as shown, thedressing body 102 can include a laminated structure comprising more thanone layer.

By way of example only, in the embodiment of FIGS. 1-6, the dressingbody 102 includes a top layer 128 having a first major surface 130 thatdefines at least a portion of the overall first major surface 110 of thedressing body 102, and a second major surface 132 configured to becoupled to a lower layer of the dressing body 102. For example, in someembodiments, as shown, the second major surface 132 can include asecuring adhesive 133 that can have similar properties as the securingadhesive 117 of the flap 104, which is described in greater detailbelow.

As further shown, in some embodiments, the dressing body 102 can furtherinclude a base layer 138 having a first major surface 140 and a secondmajor surface 142 that defines at least a portion of the overall secondmajor surface 112 of the dressing body 102 and can therefore include theskin-contact adhesive 115. Other layers can be employed in the dressingbody 102, and the top layer 128 and the base layer 138 are shown by wayof example only.

As further shown by way of example only, the base layer 138 istransparent, and the top layer 128 includes an opening 134 formedtherethrough, such that the top layer 128 and the base layer 138together form the transparent window 109. However, it should beunderstood that other configurations are possible, such as where thebase layer 138 is more opaque and includes the opening 134, and the toplayer 128 is transparent and forms an overlay liner for the base layer138. In still other embodiments, the dressing body 102 can include onesingle layer and can be transparent in the region of the transparentwindow 109.

In embodiments in which the base layer 138 includes the opening 134 andthe top layer 128 is transparent and forms an overlay liner (or film)over the base layer 138, a variety of configurations can be employed.For example, in some embodiments, the top layer 128 can be free ofadhesive, and the base layer 138 can include an adhesive on its firstmajor surface 140 and its second major surface 142, such that theportion of the top layer 128 that overlaps the opening 134 (and, e.g.,the insertion site 65) is free of adhesive. In such embodiments, thefirst major surface 140 of the base layer 138 can include a securingadhesive (e.g., an acrylate adhesive), and the second major surface 142(defining at least a portion of the overall second major surface 112 andbeing skin-facing) can include the skin-contact adhesive 115 (e.g., asilicone adhesive). Also, in such embodiments, the portion of the toplayer 128 overlapping the opening 134 presents no adhesive to themedical article 60 and/or the skin 50 underneath.

Furthermore, in some embodiments in which the base layer 138 includesthe opening 134 and the top layer 128 is transparent and forms anoverlay liner (or film) over the base layer 138, the second majorsurface 132 of the top layer 128 can include the securing adhesive 133(e.g., an acrylate adhesive), and the second major surface 142 of thebase layer 138 can include the skin-contact adhesive 115 (e.g., asilicone adhesive). In such embodiments, the portion of the top layer128 overlapping the opening 134 presents the securing adhesive 133 tothe medical article 60 and/or the skin 50 underneath.

Still, in some embodiments in which the base layer 138 includes theopening 134 and the top layer 128 is transparent and forms an overlayliner (or film) over the base layer 138, the second major surface 132 ofthe top layer 128 can include a skin-contact adhesive (e.g., theskin-contact adhesive 115, e.g., a silicone adhesive), and the secondmajor surface 142 of the base layer 138 can include the skin-contactadhesive 115 (e.g., a silicone adhesive). In such embodiments, theportion of the top layer 128 overlapping the opening 134 presents askin-contact adhesive to the medical article 60 and/or the skin 50underneath.

The skin-contact adhesive 115 is generally a pressure-sensitiveadhesive, and particularly is a pressure-sensitive adhesive that iscapable of securely but releasably adhering or bonding to skin (e.g.,mammalian skin). The skin-contact adhesive 115 is also generally safeand non-toxic. Skin-contact adhesive layers will generally be selectedaccording to the desired end use of the dressing body 102. In someembodiments, the dressing body 102 can include more than oneskin-contact adhesive 115. Where the dressing body 102 comprises morethan one skin-contact adhesive layer 115, each skin-contact adhesivelayer 115 may be selected independently of each other with regard tomaterial and thickness used. Examples of suitable skin-contact adhesivesare described in greater detail below.

In some embodiments, e.g., in embodiments employing silicone adhesives,the dressing body 102 and the skin-contact adhesive 115 can beperforated to provide openings from the first major surface 110 of thedressing body 102 all the way through the second major surface 112 andthe skin-contact adhesive 115, which can enhance permeability of thedressing body 102 and can minimize moisture build-up at the skin surfaceunderlying the dressing body 102.

The medical dressing 100 can further include one or more release linersthat can provide a release layer or surface to the skin-contact adhesive115 on the second major surface 112 of the dressing body 102 prior touse. Examples of liners suitable for use with medical dressings of thepresent disclosure are described below.

In some embodiments, as shown in FIGS. 1-6, the fixed end 120 of theflap 104, and particularly, the second major surface 116 of the flap 104in the area of the fixed end 120, can be adhered or otherwise secured orcoupled to the first major surface 110 of the dressing body 102. Inother embodiments, for example, as shown in FIGS. 7-8 and describedbelow, the fixed end 120 of the flap 104 can be integrally formed withthe dressing body 102, or provided by a portion of the dressing body102, and separated from the dressing body 102 (or a remainder of thedressing body 102) by a living hinge.

In some embodiments, a low adhesion coating (low adhesion backsize orLAB) may be provided on the first major surface 110 of the dressing body102 (e.g., on the first major surface 130 of the top layer 128) at leastin a region that that comes in contact with the carrier layer 146 and/orthe flap 104. The low adhesion coating can reduce the need to change theentire medical dressing 100 (or the dressing body 102) due to unwanteddressing removal when other tapes or devices are placed on the medicaldressing 100 (or the dressing body 102) and removed, and can also reducethe surface friction of the medical dressing 100 on linen or otherfabrics, thereby offering additional protection against the accidentalremoval of medical dressing 100. A description of a low adhesion backingmaterial suitable for use with medical dressings of the presentdisclosure can be found in U.S. Pat. Nos. 5,531,855 and 6,264,976, whichare incorporated herein by reference in their entirety.

As shown in FIGS. 1-6, the flap 104 can include the securing adhesive117 on its second major surface 116 in the area of (or adjacent) thefixed end 120 and the free end 120. A release liner 124 can be employedto cover the securing adhesive 117 on the free end 122 of the flap 104until it is desired to move free end 122 of the flap 104 into the secondposition P₂ and secure the second major surface 116 of the flap 104 tothe dressing body 102 and/or the medical article 60 using the securingadhesive 117. That is, in some embodiments, a first portion of thesecond major surface 116 of the flap 104 (i.e., adjacent or includingthe fixed end 120 of the flap 104) can be secured by the securingadhesive 117 to the first major surface 110 of the dressing body 102,and a second portion of the second major surface 116 of the flap 104(i.e., adjacent or including the free end of the flap) can include theremovable release liner 124 covering the securing adhesive 117 prior touse.

In some embodiments, as shown in FIGS. 1-6, the securing adhesive 117can be continuous along the second major surface 116 of the flap 104,and while the fixed end 120 is adhered to the first major surface 110 ofthe dressing body 102, the free end 122 can be covered by the releaseliner 124 prior to use. However, in some embodiments, there can bemultiple sections of the securing adhesive 117. For example, in someembodiments, one portion of the securing adhesive 117 can be locatedadjacent the fixed end 120 of the flap 104 and another portion of thesecuring adhesive 117 can be located adjacent the free end 122 of theflap 104 in such a way that a middle section of the flap 104 remainsfree of the securing adhesive 117. In such embodiments, a portion (e.g.,the ultimate end) of the free end 122 of the flap 104 can still beadhered to the dressing body 102 when in the second position P₂ toprovide some security to the medical article secured, but lifting of theflap 104 would not cause unnecessary or painful pulling motions on thesecured medical article.

In some embodiments, different securing adhesives can be employedadjacent the fixed end 120 and the free end 122 of the flap 104, and insome embodiments, the same securing adhesive 117 can be employed acrossthe entire second major surface 116 of the flap 104.

In embodiments such as the embodiment of FIGS. 1-6 where the fixed end120 of the flap 104 is adhered to the first major surface 110 of thedressing body 102, the flap 104 itself can include a living hinge 125(see FIGS. 1 and 6) about which the free end 122 of the flap 104 canpivot between the first position P₁ and the second position P₂. By wayof example only, the flap 104 can be used to secure a proximal portionof the medical article 60, e.g., proximal with respect to the insertionsite 65 in the case where the medical article 60 is a catheter system,and the flap 104 can be used to secure the input catheter 62 to thedressing body 102.

As shown, in some embodiments, the medical dressing 100 can furtherinclude one or more auxiliary tape strips 145 that can be used tofurther secure other portions of the medical article 60 (e.g., moreproximal portions of the input catheter 62) to the patient's skin 50. Asshown, the auxiliary tape strips 145 can be provided by an optionalcarrier or frame layer 146 and are not coupled to the dressing body 102,particularly, not in the same way as the flap 104. The auxiliary tapestrips 145 are optional and only shown by way of example only.

The carrier layer 146 is optionally positioned over the dressing body102. The carrier layer 146 can be a single piece of material, such as apolymeric film, or can be two or more distinct pieces. In the embodimentof FIGS. 1-6, the carrier layer 146 comprises at least one portion thatextends beyond the edge of the dressing body 102 to form a tab 148. Thetab 148 can be held during positioning of the medical dressing 100. Therelease liner for the medical dressing 100 can also include a tab thatcorresponds in shape, size and relative position to the tab 148 of thecarrier layer 146.

As shown, the carrier layer 146 can extend along at least a portion ofthe periphery of the dressing body 102 and form a window 149 exposing aportion of the dressing body 102. As such, the carrier layer 146 and itswindow 149 form a frame extends slightly less than completely around theperimeter of the dressing body 102. The window 149 allows the dressingbody 102 to be placed over the medical article 60 while still beingattached to the carrier layer 146 to increase the ease of handling ofdressing body 102 (or the medical dressing 100 as a whole).

As further shown in FIGS. 1-6, in some embodiments, the dressing body102 can include a perimeter (or peripheral region) 152 surrounding acentral portion 154 of the dressing body 102, and a recess (or slit ornotch) 156 extending from the perimeter 152 into a central portion 154of the dressing body 102, the recess 156 configured to allow a portion(e.g., an elongated member, such as a percutaneous device, e.g., acatheter) of a medical device 60 to pass therethrough. As shown, in someembodiments, the recess 156 can be formed in the proximal portion 108 ofthe dressing body 102 and can extend through the proximal end 107 of thedressing body 102. For example, the recess 156 can allow the dressingbody 102 to conform around bulky parts of the medical article 60, or mayconform around portions of the device that exit the area of dressingapplication, such as a catheter line. By way of example, in embodimentsemploying a catheter system as the medical article 60, the recess 156can be configured to allow a portion (e.g., the proximal portion 70) ofthe medical article 60 (e.g., the input catheter 62 that is proximalrelative to the insertion site 65) to pass from the second major surface112 of the dressing body 102 to the first major surface 110 of thedressing body 102, to allow the portion of the medical article 60 toreside on top of the dressing body 102 when the medical dressing 100 iscoupled to the patient. In such cases, the second major surface 112 ofthe dressing body 102 can still include the skin-contact adhesive 115,such that after the portion of the medical article 60 is passed from thesecond major surface 112 of the dressing body 102 to the first majorsurface 110 of the dressing body 102 via the recess 156, the secondmajor surface 112 of the dressing body 102 that is located adjacent (orthat defines) the recess 156 can be secured to the skin 50 with theskin-contact adhesive 115.

Such a configuration can be advantageous, for example, when the dressingbody 102 employs a weaker, gentler or less aggressive skin-contactadhesive 115 on its second major surface 112 (e.g., a silicone-based orsilicone-containing adhesive) that may not be particularly suitable foradhering to the medical article 60. In such embodiments, the flap 104can include a stronger or more aggressive securing adhesive 117 (e.g.,as compared to the skin-contact adhesive, such as an acrylate-based oracrylate-containing adhesive) that can be more suitable for adhering tothe medical article 60 and/or the dressing body 102. Said another way,the adhesion between the second major surface 112 of the dressing body102 and the skin (or skin surface) 50 is less than the adhesion betweenthe second major surface 116 of the flap 104 and the first major surface110 of the dressing body 102.

As a result, the recess 156 can allow a portion of the medical article60 to pass therethrough to allow the skin-contact adhesive 115 to adhereto the patient's skin 50 (e.g., under the portion of the medical article60, as shown in FIG. 1), while also allowing the flap 104 to secure theportion of the medical article 60 with the securing adhesive 117 to thefirst major surface 110 of the dressing body 102, adjacent the recess156, without adhering the securing adhesive 117 to the patient's skin50. As a result, the portion of the medical article 60 can be coupled(e.g., sandwiched) between the flap 104 and the dressing body 102.Furthermore, the free end 122 of the flap 104 can at least partiallyoverlap or cover at least a portion of the recess 156 in the dressingbody 102, when the free end 122 of the flap 104 is in the secondposition P₂, to inhibit movement (e.g., longitudinally, laterally and/orvertically) of the portion of the medical article 60 desired to besecured. That is, in embodiments employing a catheter system as themedical article 60, the insertion site 65, the output catheter 66, andat least a portion of the catheter hub 64 can be covered by the distalportion 106 of the dressing body 102 that is free of the flap 104, andat least the input catheter 62 can be secured using the flap 104.Further details of the skin-contact adhesive 115 and the securingadhesive 117 are described in greater detail below.

In some embodiments, e.g., as shown in FIGS. 11 and 12 and describedbelow, the flap 104 can be one of a plurality of flaps 104 that can beoriented in parallel or in opposing fashion (e.g., hinging on oppositesides of the dressing body 102), or a combination thereof. In addition,even though the fixed end 120 of the flap 104 is illustrated as beinglocated on a side of the dressing body 102 such that the flap 104 opensand closes sideways, it should be understood that the fixed end 120 (andthe hinge 125) can be located anywhere on or adjacent the dressing body102 to achieve a flap 104 that overlaps the proximal portion 108 of thedressing body 102, such that the distal portion 106 of the dressing body102 remains free of the flap 104. For example, in some embodiments, asshown in FIG. 14 and described below, the fixed end 122 (and the hinge125) of the flap 104 can be located just proximally of the transparentwindow 109 of the dressing body 102 and can flap down (or close)proximally to overlap the dressing body 102 and to move to the secondposition P₂. Furthermore, in some embodiments, the fixed end 122 (andthe hinge 125) of the flap 104 can be located at or adjacent theproximal end 107 of the dressing body 102 such that the flap 104 canflap distally to overlap the dressing body 102 and to move to the secondposition P₂, i.e., while still allowing the distal portion 106 of thedressing body 102 to remain free of the flap 104.

FIGS. 3-5 depict an exemplary method of applying the medical dressing100 to a patient. In FIGS. 3-5, the medical dressing 100 is depicted ascovering the medical article 60, wherein the medical article 60 is theabove-described catheter system. The medical dressing 100 can be appliedto a patient by first cleaning the application area of the skin 50 andinserting the output catheter 66 into the patient at the insertion site65. The release liner can then removed from the medical dressing 100,exposing the second major surface 112 of the dressing body 102 (coatedwith the skin-contact adhesive 115). Once removed from release liner,the medical dressing 100 can be positioned on the skin 50 such that thetransparent window 109 covers the insertion site 65, the distal portion106 of the dressing body 102 covers the insertion site 65, the outputcatheter 66 and at least a portion of the catheter hub 64, and theproximal portion 108 of the dressing body 102 and the flap 104 covers atleast a portion of the input catheter 62 and optionally a portion of thecatheter hub 64, for example. The edges of the medical dressing 100 canthen be gently and smoothly pressed against the patient's skin 50,thereby bringing the exposed skin-contact adhesive 115 in contact withthe patient, as shown in FIG. 3. The catheter line 62 is pulled throughthe recess 156 to exit the dressing 102.

As shown in FIG. 3, the release liner 124 coupled to the second majorsurface 116 of the free end 122 of the flap 104 can be removed to exposethe securing adhesive 117 on the second major surface 116 of the flap104. The free end 122 of the flap 104 can then be moved from the firstposition P₁ (FIG. 3) to the second position P₂ (FIG. 4) over at least aportion of the input catheter 62, the proximal portion 108 of thedressing body 102, and the recess 156, adhering the securing adhesive117 to the first major surface 110 of the dressing body 102 and securingthe medical article 60.

After the dressing body 102 and the flap 104 are properly in positionand adhered to a patient's skin 50, the carrier layer 146 can beremoved, as shown in FIG. 4. Generally, removal of the carrier layer 146can be accomplished by grasping the carrier layer 146, e.g., at area 147and using a peeling motion toward the edges of the medical dressing 100to remove the carrier layer 146. After application of the medicaldressing 100, the optional auxiliary tape strips 145 can be placed overportions of the dressing body 102 and/or over portions of the medicalarticle 60, such as further proximal portions of the input catheter 62that have exited the dressing body 102 via the recess 156, as shown inFIG. 5. The tape strips 145 can be provided with the medical dressing100 as shown and described, or may be supplied separately.

The layers and materials discussed above are further described in detailbelow.

In some embodiments, an optional antimicrobial component may be includedthat is either separate from the medical dressing 100 or may be integralwith the medical dressing 100. When employed, the antimicrobialcomponent can be placed near or adjacent to the insertion site 65 of themedical article 60 to inhibit microbial growth in and around theinsertion site 65. The antimicrobial component can include an absorbentfoam or gel, such as used in a 3M® TEGADERM® CHG I.V. SecurementDressing, available from 3M Company.

Dressing Body and Flap

Suitable dressings for the dressing body 102 can include, but are notlimited to, one or more of a fabric, a woven fibrous web, a nonwovenfibrous web, a knit, a polymeric film, other familiar dressingmaterials, or combinations thereof. The dressing materials (e.g., forthe base layer 138) can be translucent or transparent polymeric elasticfilms, and can include, but are not limited to, films formed ofelastomeric polyurethanes, co-polyesters, polyethylenes, or combinationsthereof. The dressing body 102 (e.g., the base layer 138 in theembodiment of FIGS. 1-6) can be a high moisture vapor permeable film.U.S. Pat. No. 3,645,835 describes methods of making such films andmethods for testing their permeability.

The dressing body 102 advantageously should transmit moisture vapor at arate equal to or greater than human skin. In some embodiments, theadhesive-coated dressing body 102 can transmit moisture vapor at a rateof at least 300 g/m²/24 hrs/37° C./100-10% RH, and in some embodiments,at least 700 g/m²/24 hrs/37° C./100-10% RH. The dressing body 102 isgenerally conformable to anatomical surfaces. As such, when the dressingbody 102 is applied to an anatomical surface, it conforms to the surfaceeven when the surface is moved. The dressing body 102 can also beconformable to animal anatomical joints. When the joint is flexed andthen returned to its unflexed position, the dressing body 102 can bemade such that it stretches to accommodate the flexion of the joint, butis resilient enough to continue to conform to the joint when the jointis returned to its unflexed condition.

As mentioned above, the dressing body 102 can be a single layer ofmaterial or may be comprised of two or more layers, such as the toplayer 128 and the base layer 138. The dressing body 102 can be aflexible material. For example, the dressing body 102, or a portionthereof (e.g., the top layer 128 or the base layer 138, or both) may bea film, paper, woven, knitted, or nonwoven material or a combination ofone or more layers of film, paper, woven, knitted, or nonwoven. In someembodiments, a transparent material for at least one of the top layer128 and the base layer 138 can be desirable to allow for viewing of theunderlying skin or medical device.

To add strength to a very thin film, all or a portion of the film mayinclude an additional layer of another film, woven, knitted, or nonwovenfabric. For example, a 3M® TEGADERM® I.V. Advanced Dressing, availablefrom 3M Company, includes a portion of the dressing which additionallyincludes a nonwoven substrate secured to a thin, transparent film.

In embodiments employing the top layer 128 and the base layer 138 (andoptionally, additional layers), the top layer 128 and the base layer 138can be formed of any of the materials described above. By way of exampleonly, in some embodiments, the top layer 128 can be formed of a nonwovenavailable under the trade designation SONTARA® from DuPont Corporation,Wilmington, Del. and the securing adhesive 133, and the base layer 138can be formed of a film available under the trade designation TEGADERM®from 3M Company, St. Paul, Minn. As described above, in someembodiments, the top layer 128 can actually be positioned underneath thebase layer 138.

The flap 104 can be formed of any of the materials described above withrespect to the dressing body 102.

Carrier Layer

The material used to form the carrier layer 146 is generallysubstantially more rigid than the dressing body 102 to prevent thedressing body 102 from improperly wrinkling during application to apatient. The carrier layer 146 can be heat-sealable to the dressing body102 with or without a low adhesion coating described above. In general,the carrier layer materials can include, but are not limited to,polyethylene/vinyl acetate copolymer-coated papers and polyester films.One example of a suitable carrier layer material is a polyethylene/vinylacetate copolymer coated super calendared Kraft paper (1-80BKG-157 PE;LOPAREX of Willowbrook, Ill.).

The carrier layer 146 can include perforations to aid in separatingportions of the carrier layer 146 after application of the medicaldressing 100 to a patient. Spacing and shape of the perforations areadjusted to give a carrier layer with relatively easy to tearperformance on removal of the carrier layer from the applied dressing.The perforations may be shaped in accordance with any of the acceptedperforation patterns including linear, angled, Y-shaped, V-shaped,dual-angled offset, sinusoidal, etc.

Release Liner

Release liners suitable for use with the medical dressings of thepresent disclosure can be made of can include, but are not limited to,kraft papers, polyethylene, polypropylene, polyester, or combinationsthereof. Such liners can be coated with release agents, such asfluorochemicals, silicones, or other suitable low surface energymaterials. Other adhesives and release liner combinations known to thoseof ordinary skill in the art can also be employed in the medicaldressings of the present disclosure. Examples of commercially availablesilicone coated release papers are POLYSLIK™, silicone release papersavailable from Rexam Release (Bedford Park, Ill.) and silicone releasepapers supplied by LOPAREX (Willowbrook, Ill.). Other non-limitingexamples of such release liners commercially available includesiliconized polyethylene terephthalate films, commercially availablefrom H. P. Smith Co., and fluoropolymer coated polyester films,commercially available from 3M Company (St. Paul) under the brand“SCOTCHPAK™” release liners.

Adhesives

As described above, the securing adhesives 117 and 133 can have anadhesion that is higher than the skin-contact adhesive 115. In someembodiments, the securing adhesive 117, 133 and the skin-contactadhesive 115 may be of the same or similar classes of adhesive, but havedifferent adhesion levels. For example, the securing adhesive 117, 133and/or the skin-contact adhesive 115 may be an acrylate, silicone,urethane, hydrogel, hydrocolloid, natural rubber, or synthetic rubber.Adhesion can also be tuned through changes in adhesive composition,adhesive thickness, or adhesive surface area (e.g., by employing apattern-coated adhesive).

“Adhesion” refers to the force required to separate an adhesive from anunderlying substrate. Adhesion can be measured in a number of ways. Forexample, adhesion can be defined by peel force or shear force. In someembodiments, adhesion can be defined by peel adhesion using ASTMD3330/D3330M-04(2010). In some embodiments, adhesion can be defined byshear adhesion using ASTM D3654M-06(2011). Adhesion is highly dependenton the specific substrate being adhered to, as well as the time thepressure-sensitive adhesive (PSA) is allowed to dwell on the substrate.

For example, typical peel adhesion values exhibited bypressure-sensitive adhesives in medical dressings maybe in the range of20 to 300 g/cm as measured from stainless steel. In some embodiments, atleast 10% higher peel adhesion, as measured by ASTMD3330/D3330M-04(2010), of the securing adhesive 117, 133 over theskin-contact adhesive 115 may realize the benefit of both securing tothe medical article 60, while providing gentle adhesion to the skin 50.

In some embodiments, the securing adhesive 117, 133 can be an acrylateadhesive and the skin-contact adhesive 115 can be a silicone adhesive.The term “acrylate” or “acrylate-based” or “acrylate-containing” refersto monomeric acrylic or methacrylic esters of alcohols. Acrylate andmethacrylate monomers are referred to collectively herein as “acrylate”monomers. Materials that are described as “acrylate-based” or“acrylate-containing” contain at least some acrylate monomers and maycontain additional co-monomers.

Acrylate adhesives are well suited for securing adhesive dressings tomedical articles, or skin. The adhesion can be manipulated to have highadhesion or low adhesion. Generally, the adhesion between acrylateadhesives and another material will increase over time. This propertymakes acrylate adhesives well suited as the securing adhesive 117, 133,which is intended to secure the medical article 60.

Suitable acrylate adhesives that can be applied to skin such as theacrylate copolymers are described in U.S. Pat. No. RE 24,906, thedisclosure of which is hereby incorporated by reference. In particular,a 97:3 iso-octyl acrylate: acrylamide copolymer. Another acrylateadhesive is an 70:15:15 isooctyl acrylate: ethyleneoxide acrylate:acrylic acid terpolymer, as described in U.S. Pat. No. 4,737,410(Example 31), the disclosure of which is hereby incorporated byreference. Other useful acrylate adhesives are described in U.S. Pat.Nos. 3,389,827, 4,112,213, 4,310,509, and 4,323,557, the disclosures ofwhich are incorporated herein by reference.

The term “silicone” or “silicone-based” or “silicone-containing” refersto polymers that contain units with dialkyl or diaryl siloxane (—SiR₂O—)repeating units. The silicone-based polymers may be segmented copolymersor polysiloxanes polymers. The terms silicone and siloxane are usedinterchangeably.

Generally, silicone adhesives are able to effectively secure dressingsand tape to skin and upon removal from the skin produce little or noskin damage. Typically, silicone adhesives do not adhere well topolymer-based substrates, like tubing or hardgoods, for example that areoften present in medical articles. Thus lack of strong adhesion tomedical devices/tubing combined with the gentle removal of siliconeadhesives from skin make these adhesives well suited as the skin-contactadhesive 115.

Examples of suitable silicone adhesive systems can include, but are notlimited to, products available under the following trade designations:Dow Corning MG 7-9850, Wacker SILPURAN® 2110 and 2130, BluestarSILBIONE® RT Gel 4317 and 4320, Nusil MED-6345 and 6350. Other examplesof suitable silicone adhesives are disclosed in PCT PublicationsWO2010/056541, WO2010/056543 and WO2010/056544, the disclosures of whichare incorporated herein by reference.

For skin-contact adhesives, it is desirable that the adhesive is able totransmit moisture vapor at a rate greater to or equal to that of humanskin. While such a characteristic can be achieved through the selectionof an appropriate adhesive, it is also contemplated that other methodsof achieving a high relative rate of moisture vapor transmission may beused, such as perforating the adhesive or pattern coating the adhesive,as described in U.S. Pat. No. 4,595,001 and U.S. Pat. App. Pub.2008-0233348, the disclosures of which are incorporated herein byreference. Each of the securing or skin-contact adhesive can optionallybe applied in a discontinuous manner.

Additional exemplary embodiments of medical dressings of the presentdisclosure will now be described with respect to FIGS. 7-14. FIGS. 7-14illustrate various medical dressings of the present disclosure, whereinlike numerals represent like elements. The medical dressings of FIGS.7-14 share many of the same elements, features, and functions as themedical dressing 100 described above with respect to FIGS. 1-6.Reference is made to the description above accompanying FIGS. 1-6 for amore complete description of the features and elements (and alternativesto such features and elements) of the embodiments illustrated in FIGS.7-14. Any of the features described above with respect to FIGS. 1-6 canbe applied to the embodiments of FIGS. 7-14, and vice versa. The samemedical article 60 illustrated in FIGS. 1 and 3-6 as being coupled tothe medical dressing 100 can also be used with each of the medicaldressings of FIGS. 7-14 and will be described with respect to each ofFIGS. 7-14 by way of example only.

FIGS. 7-8 illustrate a medical dressing 200 according to anotherembodiment of the present disclosure. The medical dressing 200 includesa dressing body 202 having a distal end 205, a distal portion 206, a toplayer 228, a base layer 238, a transparent window 209 in the distalportion 206, a proximal end 207, a proximal portion 208, a first majorsurface 210 (e.g., defined by the top layer 228), a second major surface212 (e.g., defined by the base layer 238) comprising a skin-contactadhesive 215; and a recess 256. The medical dressing 200 furtherincludes a flap 204 integrally formed with the dressing body 202 andcomprising a fixed end 220 coupled to the dressing body 202 andseparated from the remainder of the dressing body 202 by a living hinge225, a free end 222, a first major surface 214 (see FIG. 8), a secondmajor surface 216 comprising a securing adhesive 217, and a releaseliner 224 coupled to the second major surface 216, i.e., prior to use.FIG. 7 illustrates the flap 204 in a first (open) position P₁ with therelease liner 224, and FIG. 8 illustrates the flap 204 in a second(closed) position P₂, where it is further shown as securing the medicalarticle 60 between the flap 204 and the first major surface 210 of thedressing body 202.

The medical dressing 200 includes many similarities with the medicaldressing 100 of FIGS. 1-6, except that the medical dressing 200 of FIGS.7-8, except that the fixed end 220 of the flap 204 is integrally formedwith the dressing body 202 and is separated from the dressing body 202by a living hinge 225. By way of example only, the flap 204 of theembodiment of FIGS. 7-8 is formed only of the top layer 228 of thedressing body 202 and not the base layer 238; however, it should beunderstood that the flap 204 can be formed of the top layer 228, thebase layer 238, or both.

FIGS. 9-10 illustrate a medical dressing 300 according to anotherembodiment of the present disclosure. The medical dressing 300 includesa dressing body 302. The dressing body 302 includes a top layer 328, abottom layer 338, a distal end 305, a distal portion 306, a transparentwindow 309 in the distal portion 306, a proximal end 307, a proximalportion 308, a first major surface 310, a second major surface 312comprising a skin-contact adhesive 315; and a recess 356. The medicaldressing 300 includes many similarities with the medical dressing 100 ofFIGS. 1-6, except that in the medical dressing 300 of FIGS. 9-10 the toplayer 328 of the dressing body 302 (and particularly, in the proximalportion 308 of the dressing body 302) forms the flap 304, such that theflap 304 is integrally formed with at least a portion (i.e., the toplayer 328) of the dressing body 302, and is separated from the remainderof the dressing body 302 (i.e., the remainder (distal portion 306) ofthe top layer 328 of the dressing body 302) by a living hinge 325. Asshown, the living hinge 325 can be positioned to extend transverselywith respect to a longitudinal axis A′ (see FIG. 9) of the dressing body302, separating the distal portion 306 of the top layer 328 from theproximal portion 308.

The top layer 328 of the dressing body 302, and particularly, the distalportion 306 thereof, serves as a fixed end 320 of the flap 304 that iscoupled to the dressing body 302. The proximal portion 308 of the toplayer 328 serves as a free end 322 of the flap 304. The top layer 328further includes an opening 334 (FIG. 9) defining the transparent window309. Thus, no portion of the flap 304 interferes with visualizing adistal portion of a medical article, and the movable free end 322 of theflap 304 is still located toward the proximal end 307 of the dressingbody 302, such that the distal portion 306 of the dressing body 302 isstill “free of the flap” 304.

The flap 304 (or at least the free end 322 of the flap 304) furtherincludes a first major surface 314, a second major surface 316comprising a securing adhesive 317, and a release liner 324 coupled tothe second major surface 316, i.e., prior to use. The flap 304 isillustrated in a first (open) position P₁ in FIGS. 9 and 10, but theflap 304 is movable to a second (closed) position to secure a medicalarticle between the top layer 328 (i.e., the free end 322 of the flap304) and the base layer 338 of the dressing body 302 and to overlap theproximal portion 308 of the base layer 338 and at least a portion of therecess 356. The recess 356 can be used as described above to allow theportion of the medical article that is to be secured by the flap 304 tobe located between the flap 304 and the base layer 338 of the dressingbody 302.

The top layer 328 (or the fixed end 320 of the flap 304) can include afirst major surface 330 and a second major surface 332 opposite thefirst major surface 330 and including a securing adhesive 333. The baselayer 338 can include a first major surface 340 and a second majorsurface 342. The second major surface 332 of the top layer 328 ispositioned to be coupled to the first major surface 340 of the baselayer 338, and the second major surface 342 of the base layer 338 isconfigured to be coupled to skin. As a result, the first major surface330 of the top layer 328 can correspond to the overall first majorsurface 310 of the dressing body 302, and the second major surface 342of the base layer 338 can correspond to the overall second major surface312 of the dressing body and can include the skin-contact adhesive 315.By way of example only, the second major surface 342 of the base layer328 can include a silicone-based or a silicone-containing adhesive andthe second major surface 332 of the top layer 328 can include anacrylate-based or a an acrylate-containing adhesive.

FIG. 11 illustrates a medical dressing 400 according to anotherembodiment of the present disclosure. The medical dressing 400 includesa dressing body 402 and two flaps 404 that oppose one another and canfunction together to a secure a medical article. The two opposing flaps404 can be configured to couple to one another (e.g., via a securingadhesive 417) and/or to a first major surface 410 of the dressing body402.

FIG. 12 illustrates a medical dressing 500 according to anotherembodiment of the present disclosure. The medical dressing 500 includesa dressing body 502 and two or more flaps 504 that oppose one anotherand are spaced longitudinally apart from one another along alongitudinal axis A″ of the dressing body 502, such that one flap 504 islocated further distally than another (or one is located more proximallythan another), and such that the multiple flaps 504 can be used tosecure different portions of a medical article, for example, along itslength.

FIG. 13 illustrates a medical dressing 600 according to anotherembodiment of the present disclosure. The medical dressing 600 includesa dressing body 602 and is an example of an embodiment in which asecuring adhesive 617 for a flap (not shown, but any of theabove-described flaps can be employed) can be provided by one or moreadhesive landing pads 665 located on a first major surface 610 of thedressing body 602. In some embodiments, one or more adhesive landingpads 665 can be used to secure the free end of a flap, and in someembodiments, the adhesive landing pads 665 can be used to secure boththe fixed end and the free end of a flap of the present disclosure.

FIG. 14 illustrates a medical dressing 700 according to anotherembodiment of the present disclosure. The medical dressing 700 includesa dressing body 702 and a flap 704. The flap 704 includes one or moreslits, notches or cutaway regions 770 that separate the flap 704 intomultiple portions or sections 772, e.g., which can be wrapped around amedical article (e.g., catheter tubing). By way of example only, theflap 704 includes a fixed end 720 that is coupled to the dressing body702 at a location that is proximal with respect to a transparent window709 of the dressing body 702, and wherein a free end 722 of the flap 704flaps proximally from its first position P₁ to the second position (notshown) where the flap 704 overlaps at least a portion of the dressingbody 702 and, particularly, a recess 756 in the dressing body 702.

Each embodiment shown in the figures is illustrated as a separateembodiment for clarity in illustrating a variety of features of themedical dressings of the present disclosure. However, it should beunderstood that any combination of elements and features of any of theembodiments illustrated in the figures and described herein can beemployed in the medical dressings of the present disclosure.

EMBODIMENTS

Embodiment 1 is a medical dressing, e.g., for securing a medical articleto a skin surface, the medical dressing comprising:

-   -   a dressing body comprising        -   a first major surface,        -   a second major surface, opposite the first major surface;            and    -   a flap comprising        -   a first major surface,        -   a second major surface, opposite the first major surface,            comprising a securing adhesive,        -   a fixed end coupled to the dressing body, and        -   a free end movable with respect to the dressing body between            a first position in which the free end is not positioned in            an overlapping relationship with the dressing body and a            second position in which the free end is positioned in            overlapping relationship with the dressing body;    -   wherein the second major surface of at least the free end of the        flap is configured to be secured to the dressing body; and    -   wherein the flap is located toward a proximal end of the        dressing body, such that a distal portion of the dressing body        is free of the flap.

Embodiment 2 is the medical dressing of embodiment 1, wherein the secondmajor surface of at least the free end of the flap is configured to besecured to the dressing body by a securing adhesive.

Embodiment 3 is the medical dressing of embodiment 2, wherein the fixedend of the flap is secured to the first major surface of the dressingbody with the securing adhesive.

Embodiment 4 is the medical dressing of embodiment 2 or 3, wherein afirst portion of the second major surface of the flap is secured by thesecuring adhesive to the first major surface of the dressing body, andwherein a second portion of the second major surface of the flapincludes a removable release liner covering the securing adhesive.

Embodiment 5 is the medical dressing of any of embodiments 1-4, whereinthe fixed end of the flap is integrally formed with the dressing body.

Embodiment 6 is the medical dressing of embodiment 5, wherein the fixedend of the flap is separated from the dressing body by a living hinge.

Embodiment 7 is the medical dressing of any of embodiments 1-6, whereinthe skin-contact adhesive comprises a silicone adhesive.

Embodiment 8 is the medical dressing of any of embodiments 2-7, whereinthe securing adhesive comprises an acrylate adhesive.

Embodiment 9 is the medical dressing of any of embodiments 2-8, whereinthe adhesion between the second major surface of the dressing body andthe skin surface is less than the adhesion between the second majorsurface of the flap and the first major surface of the dressing body.

Embodiment 10 is the medical dressing of any of embodiments 2-9, whereinthe skin-contact adhesive has a lower adhesion than the securingadhesive.

Embodiment 11 is the medical dressing of any of embodiments 1-10,wherein the dressing body further comprises:

-   -   a perimeter surrounding a central portion of the dressing body,        and    -   a recess extending from the perimeter into a central portion of        the dressing body.

Embodiment 12 is the medical dressing of embodiment 11, wherein the freeend of the flap overlaps at least a portion of the recess in thedressing body when the free end of the flap is in the second position.

Embodiment 13 is the medical dressing of embodiment 11 or 12, whereinthe recess is configured to allow a portion of the medical article toextend from the second major surface of the dressing body to the firstmajor surface of the dressing body.

Embodiment 14 is the medical dressing of embodiment 13, wherein the flapis positioned to secure the portion of the medical article to the firstmajor surface of the dressing body, adjacent the recess in the dressingbody.

Embodiment 15 is the medical dressing of embodiment 13 or 14, whereinthe medical article includes a catheter system comprising a catheter,and wherein the portion of the medical article includes a proximalportion of the catheter, located proximally with respect to an insertionsite.

Embodiment 16 is the medical dressing of embodiment 15, wherein theinsertion site is covered by a distal portion of the dressing body thatis free of the flap.

Embodiment 17 is the medical dressing of any of embodiments 11-16,wherein the recess is formed in a proximal portion of the dressing body.

Embodiment 18 is the medical dressing of any of embodiments 11-17,wherein the recess extends through a proximal end of the dressing body.

Embodiment 19 is the medical dressing of any of embodiments 1-18,wherein the flap is positioned in overlapping relationship with aproximal portion of the dressing body when the free end of the flap isin the second position.

Embodiment 20 is the medical dressing of any of embodiments 1-19,wherein the flap is located toward a proximal end of the dressing body.

Embodiment 21 is the medical dressing of any of embodiments 2-20,wherein a removable release liner covers at least a portion of thesecuring adhesive on the second major surface of the flap.

Embodiment 22 is the medical dressing of any of embodiments 1-21,wherein the dressing body includes a transparent window, and wherein theflap is located proximally with respect to the transparent window.

Embodiment 23 is the medical dressing of any of embodiments 1-22,wherein the second major surface of the dressing body adjacent therecess includes the skin-contact adhesive.

Embodiment 24 is the medical dressing of any of embodiments 1-23,wherein the flap is formed by a portion of the dressing body.

Embodiment 25 is the medical dressing of embodiment 24, wherein thedressing body includes a base layer and a top layer, and wherein theflap is formed by the top layer of the dressing body to secure at leasta portion of the medical article between the top layer and the baselayer of the dressing body.

Embodiment 26 is the medical dressing of embodiment 24 or 25, wherein asecond major surface of the top layer is positioned to be coupled to afirst major surface of the base layer, wherein a second major surface ofthe base layer is configured to be coupled to skin, and wherein thesecond major surface of the base layer includes a silicone adhesive andthe second major surface of the top layer includes an acrylate adhesive.

Embodiment 27 is the medical dressing of embodiment 25 or 26, whereinthe flap is separated from a remainder of the top layer by a livinghinge.

Embodiment 28 is the medical dressing of embodiment 27, wherein theliving hinge is positioned to extend transversely with respect to alongitudinal axis of the dressing body, separating a distal portion ofthe top layer from a proximal portion.

Embodiment 29 is the medical dressing of any of embodiments 1-28,wherein the flap is one of a plurality of flaps that oppose one another.

Embodiment 30 is the medical dressing of any of embodiments 2-29,wherein the second major surface of at least the free end of the flapcomprises the securing adhesive.

Embodiment 31 is the medical dressing of any of embodiments 2-30,wherein the securing adhesive is provided by at least one adhesivelanding pad on the first major surface of the dressing body.

Embodiment 32 is the medical dressing of any of embodiments 1-31,wherein the flap includes at least one slit to separate the flap intomultiple portions.

Embodiment 33 is the medical dressing of any of embodiments 1-32,wherein the fixed end of the flap is coupled to the dressing body at alocation that is proximal with respect to a transparent window of thedressing body, and wherein the free end of the flap is moves proximallyfrom the first position to the second position.

Embodiment 34 is a medical dressing comprising:

-   -   a dressing body comprising        -   a first major surface, and        -   a second major surface, opposite the first major surface,            wherein at least a portion of the second major surface            comprises a silicone adhesive; and    -   a flap comprising        -   a first major surface,        -   a second major surface, opposite the first major surface,        -   a fixed end coupled to the dressing body, and        -   a free end movable with respect to the dressing body between            an open position in which the free end is not positioned in            an overlapping relationship with the dressing body and a            second position in which the free end is positioned in            overlapping relationship with the dressing body;    -   wherein at least the free end of the flap is configured to be        secured to the dressing body by an acrylate adhesive when the        free end of the flap is in the second position.

Embodiment 35 is the medical dressing of embodiment 34, wherein aremovable release liner covers at least a portion of the acrylateadhesive on the second major surface of the flap.

Embodiment 36 is the medical dressing of embodiment 34 or 35, whereinthe fixed end of the flap is integrally formed with the dressing body.

Embodiment 37 is the medical dressing of embodiment 36, wherein thefixed end of the flap is separated from the dressing body by a livinghinge.

Embodiment 38 is the medical dressing of any of embodiments 34-37,wherein the second major surface of the fixed end of the flap is securedto the first major surface of the dressing body by the acrylateadhesive.

The embodiments described above and illustrated in the figures arepresented by way of example only and are not intended as a limitationupon the concepts and principles of the present disclosure. As such, itwill be appreciated by one having ordinary skill in the art that variouschanges in the elements and their configuration and arrangement arepossible without departing from the spirit and scope of the presentdisclosure.

All references and publications cited herein are expressly incorporatedherein by reference in their entirety into this disclosure.

Various features and aspects of the present disclosure are set forth inthe following claims.

What is claimed is:
 1. A medical dressing comprising: a dressing bodycomprising: a first major surface, a second major surface, opposite thefirst major surface, comprising a skin-contact adhesive; a transparentwindow; a perimeter surrounding a central portion of the dressing body;and a recess extending from the perimeter inward to the central portionof the dressing body; and a flap comprising: a first major surface, asecond major surface, opposite the first major surface, a fixed endintegrally connected to and provided by a portion of the dressing body,and a free end, wherein the second major surface of the flap comprises asecuring adhesive for contact with the first major surface of thedressing body; wherein the dressing body has a proximal end with theflap and recess and a distal end with the transparent window; whereinthe moveable free end is moveable with respect to the dressing body toposition in overlapping relationship with and in contact with the firstmajor surface of the dressing body and spanning the recess.
 2. Themedical dressing of claim 1, wherein the adhesion of the skin-contactadhesive is less than the adhesion of the securing adhesive.
 3. Themedical dressing of claim 1, wherein the adhesion between the secondmajor surface of the dressing body and the skin surface is less than theadhesion between the second major surface of the flap and the firstmajor surface of the dressing body.
 4. The medical dressing of claim 1,wherein the second major surface of the flap comprises a removablerelease liner covering the securing adhesive.
 5. The medical dressing ofclaim 1, wherein the skin-contact adhesive comprises a silicone adhesiveand wherein the securing adhesive comprises an acrylate adhesive.
 6. Themedical dressing of claim 1, wherein the flap is formed by a portion ofthe dressing body, wherein the dressing body includes a base layer and atop layer, and wherein the flap is formed by the top layer of thedressing body to secure at least a portion of a medical article betweenthe top layer and the base layer of the dressing body.
 7. The medicaldressing of claim 6, wherein the top layer comprises a first majorsurface and a second major surface, wherein the second major surface ofthe top layer is positioned to be coupled to a first major surface ofthe base layer, wherein a second major surface of the base layer isconfigured to be coupled to skin, and wherein the second major surfaceof the base layer includes a silicone adhesive and the second majorsurface of the top layer includes an acrylate adhesive.
 8. The medicaldressing of claim 6, wherein the flap is separated from a remainder ofthe top layer by a living hinge, and wherein the living hinge ispositioned to extend transversely with respect to a longitudinal axis ofthe dressing body, separating a distal portion of the top layer from aproximal portion of the top layer.
 9. The medical dressing of claim 1,wherein the dressing body further comprises a perimeter surrounding acentral portion of the dressing body.
 10. The medical dressing of claim9, wherein the fixed end of the flap is integrally connected to thedressing body at the perimeter of the dressing body.
 11. The medicaldressing of claim 10, wherein the medical article includes a cathetersystem comprising a catheter, and wherein the portion of a medicalarticle includes a proximal portion of the catheter, located proximallywith respect to an insertion site covered by a distal portion of thedressing body that is free of the flap.
 12. The medical dressing ofclaim 9, wherein the fixed end of the flap is integrally connected tothe dressing body at a central portion of the dressing body.
 13. Themedical dressing of claim 9, wherein the dressing body further comprisesa recess from the perimeter into the central portion of the dressingbody.
 14. The medical dressing of claim 13, wherein the free end of theflap overlaps at least a portion of the recess in the dressing body. 15.The medical dressing of claim 14, wherein the recess is configured toallow a portion of the medical article to extend from the second majorsurface of the dressing body to the first major surface of the dressingbody, and wherein the flap is positioned to secure the portion of amedical article to the first major surface of the dressing body,adjacent the recess in the dressing body.